Effectiveness of surgery for sciatica with disc herniation is not substantially affected by differences in surgical incidences among three countries: results from the Danish, Swedish and Norwegian spine registries

Abstract

Purpose Yearly incidence of surgery for symptomatic lumbar disc herniation varies and is 29/100,000 in Sweden, 46/100,000 in Denmark and 58/100,000 in Norway. This variation was used to study whether differences in surgical incidence were associated with differences in preoperative patient characteristics as well as patient-reported outcomes. Methods Data from the national spine registers in Sweden, Denmark and Norway during 2011-2013 were pooled, and 9965 individuals, aged 18-65 years, of which 6468 had one-year follow-up data, were included in the study. Both absolute and case-mix-adjusted comparisons of the primary outcome Oswestry Disability Index (ODI) and the secondary outcomes EQ-5D-3L, and Numerical Rating Scale (NRS) for leg and back pain were performed. Case-mix adjustment was done for baseline age, sex, BMI, smoking, co-morbidity, duration of leg pain and preoperative value of the dependent variable. Results Mean improvement in the outcome variables exceeded previously described minimal clinical important change in all countries. Mean (95% CI) final scores of ODI were 18 (17-18), 19 (18-20) and 15 (15-16) in Sweden, Denmark and Norway, respectively. Corresponding results of EQ-5D-3L were 0.74 (0.73-0.75), 0.73 (0.72-0.75) and 0.75 (0.74-0.76). Results of NRS leg and back pain behaved similarly. Case-mix adjustment did not alter the findings substantially. Conclusion We found no clear association between incidence of surgery for lumbar disc herniation and preoperative patient characteristics as well as outcome, and the differences between the countries were lower than the minimal clinical important difference in all outcomes.

Can a Successful Outcome After Surgery for Lumbar Disc Herniation Be Defined by the Oswestry Disability Index Raw Score?

“…Generalizability of our findings beyond the Norwegian population is supported by previous comparative studies in Scandinavian countries and the United States, who report conceding results on baseline data and clinical outcomes (effect sizes). 26 -28…”

“…Generalizability of our findings beyond the Norwegian population is supported by previous comparative studies in Scandinavian countries and the United States, who report conceding results on baseline data and clinical outcomes (effect sizes). [26][27][28] Using the GPE as an external anchor has been criticized since recall bias may exist. Moreover, the patients tend to be more focused on their current health state than health change when responding on a GPE scale, indicating a weakness of its construct validity.…”

Norwegian population norms for the EQ-5D-5L: results from a general population survey

“…The instrument has had widespread application in research including clinical trials, population health surveys, and as a health care quality indicator. The latter includes the National Health Service for England and Wales Patient-Reported Outcomes Measures (PROMs) program [ 4 ] and Norwegian and Swedish National Quality Registries (NQR) where it is the most widely used PROM [ 6 , 7 ]. The Norwegian Medicines Agency recommends the use of EQ-5D in all technology assessments [ 8 ].…”

Zukunft der operativen Therapie degenerativer Wirbelsäulenerkrankungen: Kontra – Wandel hin zu weniger Operationen aufgrund fehlender Evidenz

“…Die skandinavischen Länder weisen im Vergleich hierzu deutlich niedrigere Inzidenzen der Untergruppe der lumbalen Bandscheibeneingriffe von 29/100 000 in Schweden, 46/100 000 in Dänemark und 48/100 000 in Norwegen auf. Interessanterweise konnte anhand des skandinavischen Patientengutes gezeigt werden, dass die strengere Indikationsstellung (in Schweden) zu eher besseren Ergebnissen im Langzeitverlauf geführt hat [16]. Erwartungsgemäß war die präoperative Schmerzdauer in Schweden am längsten.…”